The Burnt-out NHS

Doctors in Scotland are suffering “stress and burnout” as growing NHS workloads take their toll, medical leaders today warned.  BMA Scotland chairman, Dr Keighley has warned that the fall in hospital bed numbers over a number of years has led to rising waiting lists and more pressure on Accident and Emergency.

Health boards and the Scottish Government are struggling to deal with the pressures of an ageing population, Westminster-led funding cuts and rising expectations from patients which include a shift towards a seven day working week in hospitals. New contracts are now being proposed for doctors, along with “radical” changes to training and greater weekend working. Dr Keighley insisted doctors are ready to look at new ways of working.

The crucial contact between doctors and patients has particularly suffered, according to Dr Keighley.

The “inexorable rise of managerialism” in the NHS has been a “major cause of dysfunction”, he added, and there is a need to return to clinical priorities. “I disagree with suggestions that managerial and process change holds the solution to sustaining high quality care and believe instead that it is only by working with doctors and other healthcare professionals that a solution will be found.

Hospital bed-boarding

Patients are being put at risk in Scotland by a lack of consultants and a shortage of acute hospital beds the Royal College of Physicians of Edinburgh (RCPE) has highlighted. A growing number of patients are being forced to stay in wards not designed to cater for their illness in a practice known as “bed-boarding”. Doctors say this delays treatment and increases the time patients stay in hospital, making them more likely to contract a superbug, like MRSA, or suffer from blood clots.

Eight out of ten physicians questioned for the survey say bed-boarding takes place year-round, and every expert said the practice had a negative impact on the quality of care patients receive. Seven out of ten RCPE members say putting patients in inappropriate wards has a negative impact on death rates and that it increases the chances of a patient being readmitted to hospital due to them not getting the correct care during their initial stay.

its an emergency

Major trauma, the commonest killer of children and adults under 45, accounts for 1,300 deaths every year in Scotland. Major trauma often involves patients arriving at hospital with multiple, complex injuries which could result in death or permanent disability, usually sustained in an accident such as a car crash or gas explosion, or from a violent situation such as a shooting or stabbing. More than half of all trauma patients have major head injuries.

Scotland is lagging behind other developed countries in its provision of care for victims of major trauma and needs to radically overhaul its approach. A report by the Royal College of Surgeons of Edinburgh said death rates for severely injured patients who are alive when reaching hospital is 40 per cent higher in the UK than in North America. But while England has reformed its healthcare policy to improve survival rates, the situation in Scotland has not yet been addressed.


Margaret Watt, chair of the Scotland Patients’ Association, said: “This is nothing short of scandalous. We have known for some time the health service in Scotland is lacking in specialist care. Trauma patients should have access to the best qualified, best doctors for the job. The report comes from specialists who work in the frontline and know what they are talking about. They can not be ignored. It will be no good politicians coming back and saying they will look into it. These recommendations are already long overdue. They should already be in place. They need to act now to ensure Scotland’s patients get the life-saving care they expect and deserve. Scotland used to be the world leader in health care – to lag behind the rest of the world is just not an option.”

The old neglected again

Older patients are “not safe” on hospital wards in Scotland because of a lack of qualified nurses to care for them according to Royal College of Nursing (RCN) findings. The report suggests there is just one nurse caring for nearly ten patients on old people’s wards. A survey of almost 1,700 nurses found that 78 per cent said comforting and talking to patients was not done or done inadequately on their last shift because of low staff numbers. Some 59 per cent said promoting mobility and self-care was left undone or unfinished, with 34 per cent saying they could not provide patients with food and drink, and 33 per cent claiming they were unable to fully help patients to the toilet or manage incontinence.

The RCN warned there was a danger that “care becomes compromised” and said that many nurses say “they are too busy to provide the standard of care they would like”. The report said: “Older people in Scotland are being let down by a lack of professionally qualified nurses in hospitals, despite nationally agreed planning for the nursing workforce. Despite older people often having the most complex needs, the evidence suggests that they regularly suffer from a severe shortage of nurses and healthcare support workers (HCSWs), coupled with an inappropriate skill mix of HCSWs to nurses."
The RCN called for a “patient guarantee” to set out the number of nurses needed on older people’s wards.

It emerged the number of nurses in Scotland’s hospitals plummeted by thousands in just over two years, with further nursing posts lost during the last few months of 2011. The RCN said the number of nursing and midwifery staff employed in Scotland had fallen by 2,190 between September 2009 and the end of 2011.

According to the RCN Scotland director, Theresa Fyffe, the number of nurses employed was at a six-year low. She said: “As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower-paid bands."

The charity Age Scotland demanded dramatic improvements to care services in the community, to keep older people “safe and out of hospital”.

health and safety??

Hospital chiefs are discouraging “whistleblowing” nurses from reporting their concerns about patient safety and staffing levels, nursing leaders have warned. More than one-third of nurses in Scotland (37%) said they had been discouraged, or told directly, not to report their concerns to their NHS health board or employer.

The Royal College of Nursing (RCN) revealed more than 80% of nurses in Scotland said they had highlighted problems. But, in more than half of cases, no action was ever taken. The overwhelming majority (84%) of nurses in Scotland fear they will be victimised if they speak out about the problems.

Theresa Fyffe, RCN Scotland director, said: “It is extremely worrying that nurses are being explicitly told not to raise concerns, particularly after all we have learned about the consequences of ignoring issues around patient safety. The survey clearly shows nurses are committed to improving care for patients, but more than half, 55%, say no action was ever taken when they raised their concerns...We are very concerned that nurses are not being listened to particularly as we know more than 2000 nurses have been cut from the NHS workforce in Scotland since September 2009, and staff are feeling over-stretched and under pressure. In these circumstances it is more important than ever they are listened to when they raise their concerns about patient safety and about staffing levels.”

http://www.heraldscotland.com/news/health/third-of-nurses-told-they-should-not-whistleblow-1.1138132